One of the difficulties with Alzheimer’s disease is the uncertainty of diagnosis. Diagnoses are often confirmed post-humously with a post-mortem, to identify the characteristic plaques and tangles in the brain. There have been numerous tests developed to diagnose the disease while patients are presenting with the symptoms, as well as predictive tests for the very early signs.
Patients who have severe dementia in their final days routinely present with a high concentration on these plaques and tangles. However, there have been several interesting cases recently of renown chess players. In their final years, these individuals were almost completely asymptomatic, still playing chess, but maybe slightly slower and forgetting the odd thing now and then. A post-mortem showed a very high concentration of plaques and tangles, associated with terminal dementia. In two brains with the same level of Alzheimer’s pathology, one patient can be almost asymptomatic whilst the other is suffering terminal dementia.
That presents a very interesting conundrum for neurology researchers – are the plaques and tangles really responsible for the symptoms? Can the symptoms be prevented if the mind is kept active and stimulated? Although only very few cases have been recorded at present, if these findings were replicated on a larger scale, they could have very large implications for the approach we take to caring for people with dementia in the very early stages